Poster: Nepal's Achievement of MDGs 4&5
1
Government of Nepal Ministry of Health & Population Department of Health Services Key Factors Contributing to Nepal's Achievement of Millennium Development Goals 4 & 5 Penny Dawson, JSI Research & Training Institute, Inc./Nepal Team e-mail : [email protected] Trend of Under-Five Mortality Rates in Nepal Policy Environment and Government Commitment and Coordination Infrastructure and Logistics System Support Trend of Maternal Mortality Ratio in Nepal Health Financing Implementation Timeline of Key Maternal, Newborn and Child Health Policies and Programs Successful Mobilization of Female Community Health Volunteers (FCHV) Government Programs (examples) n n n n n n n n Family Planning FCHV Program The Safemotherhood Program Maternity Incentive Scheme Basic and Comprehensive Essential Obstetric Care Expanded Program on Immunization Vitamin A and Deworming Community Based(CB) Newborn Care Program Government Policies and Guidelines (examples) n n n n n n n n n FCHV Strategy 1988 Health Policy 1991 ARI Treatment Guideline 1994 Safemotherhood Policy 1998 Free Maternity Services Guidelines 2009 Health Sector Strategy: An agenda for reform 2003 Neonatal Health Strategy 2004 National Policy on Skilled Birth Attendants 2005 Nepal Safemotherhood and Neonatal Longterm Health Plan 2002-17 15 Years Trend of Health Expenditure Per Capita ($) Source: National Health Accounts 2004/05 – 2008/09 (2008/09) Distribution of the Total Health Expenditure Maternity Incentive Program Indicators Achievement % of women paying for maternity services Average amount (NRs) 56.4 370 Source: Service Tracking Survey 2013 FP FCHV SM action plan Iron Folate Free Maternity Service Measles and Rubella Campaign 2011-2012 Misoprostrol Full Immunization Village and district campaign 1968 1977 1982 1988 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 ARI Vitamin A supplementation for 6 to 59 month children CB-ARI CB-CDD CB-AC CB-IMCI Nutrition Zinc CBNCP pilot Chlorhexidine CB-IMNCI EPI CDD Deworming CB-NCP expansion MNTE Campaign 2001-2004 Measles Catch up campaign 2004-2005 SBA training program Measles Follow up campaign 2008-2009 The Government of Nepal worked together with donors and partners to implement programs aligned with the policies to improve maternal and child survival. District store -Syangja Misoprostol Mothers' Group Chlorhexidine Counseling Tool Vitamin A Iron Timer OC Pills ORS/Zinc The under- five mortality rate in Nepal has surpassed the MDG target of 54 per 1000 live births. Maternal mortality declined from 539 per 100,000 live births in 1991 to 281 per 100,000 live births in 2006. The objective of this poster is to highlight some key factors which contributed to these declines. Introduction and Objective 54 34 17 0 20 40 60 80 100 120 140 1996 NDHS 2001 NDHS 2006 NDHS 2011 NDHS 2014 MICS MDG 2015 Per 1000 live births U5M IMR NMR MICS: Multiple Indicator Cluster Survey Conflict Period NDHS: Nepal Demographic Health Survey 134 0 100 200 300 400 500 600 1996 NDHS 2001 NDHS 2006 NDHS 2009 MMMS 2013 WHO estimate 2015 MDG Per 100,000 live births MMMS: Maternal Mortality and Morbidity Survey Conflict Period The World Bank estimate 2014 0 5 10 15 20 25 30 35 40 45 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Expenditure per capita ($) Government 21% Private 4% External sources 19% Out of Pocket Expenditure 56% 0 10 20 30 40 50 60 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Source: Red Book, Ministry of Finance 2003/4 to 2014/15 Donor Support (%) in the Health Sector Donors continuous support remained in health sector during the decade of Maoist Movement (1996-2006). Logistics Management Information System (1994 to present) Construction, dejunking and storage space (1994 to 2011) Introduction of Demand Based Supply Chain Model-PULL SYSTEM below district level (2004/5 to 2011) Existing Logistic Management Division (LMD) situation Nepal Public Health System After Before There are currently about 50,000 FCHVs in Nepal. They work an average of 5.1 hours per week and are not paid directly for their services. FCHVs play an important role in contributing to key public health programs and their service has contributed to the decline in maternal, neonatal and under-five mortality. 5 15 68 214 3,840 50,000 Source: DoHS Annual Reports 2012/13. Number 56 districts have CEOC facilities 163 BEOC sites 1555 birthing centers 5274 SBAs trained 75 districts – Iron, Vitamin A, Condoms, Pills, Injectables, Immunization, CBIMCI, Deworming 49 districts - Chlorhexidine 41 districts – Misoprostol Central Hospital Regional/Zonal Hospital District Hospital Primary Health Care Center FCHV Health Posts/Sub Health Post Central Electoral constituency VDC Community Level up to ward Regional/Zonal District Health Care Delivery System H H H H n n n Initiated computerized logistic system Implemented web based inventory management system including LMIS district level Rationalized forecasting and pipeline monitoring using LMIS data Conducting pilot at service delivery points, using web based LMIS in three districts n n n n LMD has its own mult - year procurement plan Nationwide over 90% reporting status from Health Facilities LMIS tracks 206 items at district level including FP and MNCH commodities Government provides 70 commodities free of charge n n n Decreased expiry and wastage of drugs Increased reliable availability of Increased reliable availability of health commodities Decreased significantly FP and MNCH related commodity stockouts at the service delivery point n n n Cleaned up nationwide warehouses and auctioned off unused items and created storage space (86,400 sq.ft.) Developed architectural design for warehouses nationwide Constructed 58 district warehouses and 14 are under construction. Technical and financial support from USAID (through JSI, DELIVER and Lifeline/Nepal), DFID, UNICEF, UNFPA. KfW and DFID/UKAID supported in construction. USAID/DELIVER Project and JSI provided technical support. USAID/H4L Logistics (Lifeline), UNFPA, UKAID/NHSSP continue support. USAID/DELIVER Project designed the pull system, revised policy and procedures, conducted comprehensive training, developed supervision and monitoring structure.
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Transcript of Poster: Nepal's Achievement of MDGs 4&5
Government of NepalMinistry of Health & PopulationDepartment of Health Services
Key Factors Contributing to Nepal's Achievement of
Millennium Development Goals 4 & 5
Maternal and Neonatal Health Situation in Nepal
Penny Dawson, JSI Research & Training Institute, Inc./Nepal Teame-mail : [email protected]
Trend of Under-Five Mortality Rates in Nepal
Policy Environment and Government Commitment and Coordination
Infrastructure and Logistics System Support
Trend of Maternal Mortality Ratio in Nepal
Health Financing
Implementation Timeline of Key Maternal, Newborn and Child Health Policies and Programs
Successful Mobilization of Female Community
Health Volunteers (FCHV)
Government Programs (examples)n
n
n
n
n
n
n
n
Family Planning
FCHV Program
The Safemotherhood Program
Maternity Incentive Scheme
Basic and Comprehensive Essential Obstetric Care
Expanded Program on Immunization
Vitamin A and Deworming
Community Based(CB) Newborn Care Program
Government Policies and Guidelines (examples)n
n
n
n
n
n
n
n
n
FCHV Strategy 1988
Health Policy 1991
ARI Treatment Guideline 1994
Safemotherhood Policy 1998
Free Maternity Services Guidelines 2009
Health Sector Strategy: An agenda for reform 2003
Neonatal Health Strategy 2004
National Policy on Skilled Birth Attendants 2005
Nepal Safemotherhood and Neonatal Longterm Health Plan 2002-17
15 Years Trend of Health Expenditure Per Capita ($)
Source: National Health Accounts 2004/05
– 2008/09
(2008/09)
Distribution of the Total Health Expenditure
Maternity Incentive Program
Indicators Achievement
% of women paying for maternity services
Average amount (NRs)
56.4
370
Source: Service Tracking Survey 2013
FP FCHV SM action plan
Iron Folate
Free Maternity Service
Measles and Rubella Campaign 2011-2012
Misoprostrol Full Immunization Village
and district campaign
19
68
19
77
19
82
19
88
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
ARI Vitamin A supplementation for 6 to 59 month
children
CB-ARI CB-CDD CB-AC CB-IMCI Nutrition Zinc CBNCP pilot Chlorhexidine CB-IMNCI
EPI CDD DewormingCB-NCP expansion
MNTE Campaign 2001-2004
Measles Catch up campaign
2004-2005
SBA training program
Measles Follow up campaign
2008-2009
The Government of Nepal worked together with donors and partners to implement programs aligned with the policies to improve maternal and child survival.
District store -Syangja
Misoprostol
Mothers' Group
Chlorhexidine
Counseling Tool
Vitamin A Iron
Timer
OC Pills
ORS/Zinc
The under- five mortality rate in Nepal has surpassed the MDG target of 54 per 1000 live births. Maternal mortality declined from 539 per 100,000 live births in 1991 to 281 per 100,000 live births in 2006. The objective of this poster is to highlight some key factors which contributed to these declines.
Introduction and Objective
54
34
17
0
20
40
60
80
100
120
140
1996 NDHS
2001 NDHS
2006 NDHS
2011 NDHS
2014 MICS
MDG 2015
Pe
r 1
00
0 li
ve b
irth
s
U5M
IMR
NMR
MICS: Multiple Indicator Cluster Survey
Conflict Period
NDHS: Nepal Demographic Health Survey
134
0
100
200
300
400
500
600
1996 NDHS
2001 NDHS
2006 NDHS
2009 MMMS
2013 WHO estimate
2015 MDG
Pe
r 1
00
,00
0 liv
e b
irth
s
MMMS: Maternal Mortality and Morbidity Survey
Conflict Period
The World Bank estimate 2014
0
5
10
15
20
25
30
35
40
45
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Exp
end
itu
re p
er c
apit
a ($
)
Government
21%
Private4%
External sources 19%
Out of Pocket Expenditure
56%
0
10
20
30
40
50
60
2003
/04
2004
/05
2005
/06
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
2011
/12
2012
/13
2013
/14
2014
/15
Source: Red Book, Ministry of Finance 2003/4 to 2014/15
Donor Support (%) in the Health Sector
Donors continuous support remained in health sector
during the decade of Maoist Movement (1996-2006).
Logistics Management Information System (1994 to present)
Construction, dejunking and storage space (1994 to 2011)
Introduction of Demand Based Supply Chain Model-PULL SYSTEM below district level (2004/5 to 2011)
Existing Logistic Management
Division (LMD) situation
Nepal Public Health System
AfterBefore
There are currently about 50,000 FCHVs in Nepal. They work an average of 5.1 hours per week and are not paid directly for their services. FCHVs play an important role in contributing to key public health programs and their service has contributed to the decline in maternal, neonatal and under-five mortality.
5
15
68
214
3,840
50,000
Source: DoHS Annual Reports 2012/13.
Number
56 districts have CEOC
facilities
163 BEOC sites
1555 birthing centers
5274 SBAs trained
75 districts – Iron, Vitamin A,
Condoms, Pills, Injectables,
Immunization, CBIMCI, Deworming
49 districts - Chlorhexidine
41 districts – Misoprostol
Central Hospital
Regional/Zonal
Hospital
District Hospital
Primary Health Care Center
FCHV
Health Posts/Sub Health Post
Central
Electoral constituency
VDC
Community Level up to ward
Regional/Zonal
District
Health Care Delivery System
H
H
H
H
n
n
n
Initiated computerized logistic systemImplemented web based inventory management system including LMIS district level Rationalized forecasting and pipeline monitoring using LMIS data Conducting pilot at service delivery points, using web based LMIS in three districts
n
n
n
n
LMD has its own mult -year procurement planNationwide over 90% reporting status from Health Facilities LMIS tracks 206 items at district level including FP and MNCH commoditiesGovernment provides 70 commodities free of charge
n
n
n
Decreased expiry and wastage of drugsIncreased reliable availability of Increased reliable availability of health commodities Decreased significantly FP and MNCH related commodity stockouts at the service delivery point
n
n
n
Cleaned up nationwide warehouses and auctioned off unused items and created storage space (86,400 sq.ft.) Developed architectural design for warehouses nationwide Constructed 58 district warehouses and 14 are under construction.
Technical and financial support from USAID (through JSI, DELIVER and Lifeline/Nepal), DFID, UNICEF, UNFPA.
KfW and DFID/UKAID supported in construction. USAID/DELIVER Project and JSI provided technical support.
USAID/H4L Logistics (Lifeline), UNFPA, UKAID/NHSSP continue support.
USAID/DELIVER Project designed the pull system, revised policy and procedures, conducted comprehensive training, developed supervision and monitoring structure.
